What is Diabetes

Type 2 Diabetes

Insulin is a hormone produced by the pancreas that allows your cells to take in glucose, a sugar molecule that is the body’s main source of energy. People with type 2 diabetes become resistant to the effects of insulin and are unable to produce enough insulin to overcome this resistance. Instead of moving glucose into the cells where it can be used as energy, the amount of glucose in the blood increases. This is called hyperglycemia.

If your blood sugar levels are elevated, you may experience signs and symptoms of diabetes. Some common signs and symptoms include increased thirst, frequent urination, extreme hunger, unexplained weight loss, fatigue, irritability, blurred vision, slow-healing sores, presence of ketones in the urine, and frequent infections, such as gum, skin, or vaginal infections.

Risk Factors for Diabetes

There are several risk factors that increase your chance of developing type 2 diabetes. These include:

  • Weight. The more fatty tissue you have, the more resistant your cells will be to insulin.
  • Inactivity. Physical activity decreases your weight and the amount of fatty tissue you have. It also uses up glucose in the blood and makes cells more sensitive to insulin.
  • Family history. You are at increased risk if your parent or sibling has a history of type 2 diabetes.
  • Race. Certain races, including Native Americans, African-Americans, Hispanics and Asian-Americans, are at increased risk of diabetes.
  • Age. The risk of developing type 2 diabetes is more common in people over 40 years.
  • Gestational diabetes. If you developed gestational diabetes during pregnancy or gave birth to a baby over 9 pounds, you are at increased risk for diabetes.
  • Polycystic ovary syndrome. Diabetes is more common in women with PCOS.
  • High blood pressure. A blood pressure above 140/90 mm Hg is linked to an increased risk of diabetes.
  • Abnormal cholesterol and triglyceride levels. If your level of HDL cholesterol, also known as good cholesterol, is low, or your level of triglycerides is high, you are at increased risk of diabetes.

Complications of Diabetes

Diabetes is linked to the development of serious and life-threatening complications. Although these complications may develop gradually over time, they may be prevented or delayed by controlling your blood glucose levels. This can be achieved through lifestyle changes, such as losing weight, exercising, and quitting smoking. Medication can also be used in combination with lifestyle changes to reduce your risk of diabetic complications.

  • Cardiovascular disease. Diabetes dramatically increases your risk of heart attack, stroke, coronary artery disease, and atherosclerosis (narrowing and hardening of blood vessels). If you have pre-existing cardiovascular disease, ask your doctor about medications, such as certain glucagon-like peptide (GLP-1) receptor agonists or sodium-glucose co-transporters (SGLT2) inhibitors, that can improve blood glucose levels and reduce the risk of heart attack, stroke, and death.
  • Kidney damage (nephropathy). Diabetes can damage your kidneys, leading to kidney failure or end-stage kidney disease over time. People with severe kidney damage may require dialysis or kidney transplant.
  • Nerve damage (neuropathy). Elevated glucose levels can damage the nerves in your feet, hands, legs, or arms and lead to tingling, numbness, burning or pain.
  • Eye damage (retinopathy). Diabetes can damage blood vessels in the eye and cause blindness. Cataracts and glaucoma are also linked to diabetes.
  • Amputations. Poor circulation in your feet and extremities may increase the risk of cuts or blisters becoming infected. If you have nerve damage, you may be unaware of these infections and may not seek treatment in time. Severe infections in your extremities may require toe, foot, or leg amputation.
  • Skin infections. Diabetes is linked to an increase in bacterial and fungal skin infections.
  • Depression. Depression is common in people with diabetes. Seek treatment if you have signs of depression as it can affect your motivation to manage your health and blood glucose levels.
  • Alzheimer’s disease. The risk of dementia is greater in people with higher blood glucose levels.

To minimize your risk of diabetic complications, it is important to control your blood glucose levels as well as your blood pressure and cholesterol levels. Your goals for each will depend on how severe your diabetes is, your age, and what other health problems you have. Ask your doctor what your target levels should be. Many people with diabetes aim for:

  • HbA1C levels below 7 percent
  • Blood pressure below 140/90 mm Hg
  • LDL cholesterol level below 100 mg/dL

Treatment Options

Some patients with diabetes may need medications to help control their diabetes in combination with diet and exercise. Depending on the severity of your diabetes, you may need more than one medication. The table below describes some of the classes of medications available to manage your blood sugar level.

Medication Class

Medication Names

How the Medication Works

Metformin

Metformin

Metformin lowers sugar production from the liver and increases the body’s sensitivity to insulin.

GLP-1 receptor agonists

Exenatide, semaglutide, liraglutide, dulaglutide, lixisenatide

GLP-1 receptor agonists increase insulin production after a meal, decrease glucose production from the liver, and suppress appetite.

Sulfonylureas

Glyburide, glipizide, glimepiride

These medications help your body produce more insulin.

Meglitinides

Repaglinide, nateglinide

These medications help your body produce more insulin.

Thiazolidinediones

Rosiglitazone, pioglitazone

These medications increase the body’s sensitivity to insulin.

DPP-4 inhibitors

Sitagliptin, saxagliptin, linagliptin, alogliptin

These medications prevent the breakdown of GLP-1, a hormone that increases insulin production after a meal.

SGLT2 inhibitors

Canagliflozin, empagliflozin, dapagliflozin, ertugliflozin

These medications prevent the kidneys from absorbing glucose and increase the loss of excess glucose through urine.

Insulin

Insulin degludec, insulin aspart, insulin detemir, insulin glargine, insulin lispro, insulin glulisine, and others

Insulin products replace missing insulin in the body and allow the cells to take in glucose.

In addition to reducing blood sugar levels, some medications to treat diabetes have other benefits. For example, GLP-1 receptor agonists help the pancreas produce more insulin after a meal and reduce the liver’s ability to make more glucose. These medications have also been shown to promote weight loss by suppressing appetite and keeping food in the stomach longer so that patients feel full sooner. Some of these medications may also decrease the risk of heart disease and stroke in people at high risk of these conditions. These medications only increase insulin production after a meal, minimizing the risk of low blood sugar.

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